Respiratory Health

13:30:00

I beg to move, That this House has considered respiratory health. It is a pleasure to serve under your chairship, Mr Rosindell. I look forward to hon. Members’ contributions to this important debate, and I thank the Backbench Business Committee for granting it. I was before the Committee a week ago on Tuesday with three requests, and I was well looked after. This is the first of my three debates; the second is on 28 November in the main Chamber, and I am waiting to hear when the third will be. I hope to get more in after that—I will keep at it. I declare an interest: I chair the all-party parliamentary group for respiratory health, and it is an issue that has affected my family. I became very aware of respiratory health because of how it affected my son. Did I understand it all? Probably not, but I understood it better from interacting with him. He is now 34 years old and married with two children, but he still has issues with his respiratory health. I am delighted to be able to raise the issue. I look forward to all the contributions, particularly the response from the Minister for Secondary Care. It is always a pleasure to see her in her place: it makes my day and everybody else’s, I am sure. I know that she has a deep interest in the subject, so I am pretty sure that we will be encouraged by what she tells us. I am also pleased to see the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), in his place. He and I have discussed the matter on a couple of occasions this week: we focused on what we would love to see come out of the debate. This debate is not about us as Members; it is about our constituents and those who contact us. It will be on behalf of all the people in this great nation of the United Kingdom of Great Britain and Northern Ireland. As chair of the APPG, I will cover issues around asthma, severe asthma, chronic obstructive pulmonary disease and silicosis. The APPG has been conducting an inquiry on silicosis in particular. We have had meetings, usually on Zoom, with at least 20 contributors; the hon. Member for Blaydon and Consett (Liz Twist) and I have attended those meetings regularly. I will frame my comments around the latest initiatives and the current policy direction, but I first want to say a few thank yous. I am indebted to Sarah Sleet and her wonderful team at Asthma and Lung UK for their outstanding help and ongoing support. They have been enormously helpful to me and the APPG and, I suspect, to other Members present. I welcome their latest report, “A Mission for Lung Health”, which was launched on Tuesday. I was there, as were some Members who are here today and many others who unfortunately cannot be. I met Dr Jonathan Fuld, the national clinical director for respiratory disease, for the first time to get his expert advice and counsel. I had always seen him on Zoom on a laptop, but on Tuesday I met him in real life: we were able to shake hands and say hello. My thanks also go to Dr Richard Russell of the British Thoracic Society for his insights and opinion, and I pay tribute to the ongoing work of our expert stakeholder groups, which comprise senior clinicians, industry professional bodies and other experts. Whenever we have that vast amount of knowledge, experience and input on a Zoom meeting, we learn quickly: I learned quickly what the issues were. There have been some very welcome developments in respiratory health recently, including the development of a new guideline for asthma, which is due to be launched soon as a collaboration among the National Institute for Health and Care Excellence, the Scottish Intercollegiate Guidelines Network and the BTS. The seasonal flu and covid vaccination programme appears to have been well planned and is rolling out well this year. Great credit and thanks are due to NHS England for its great work. Back home, where this is a devolved matter, I got two injections in one day: one for covid in the left arm and the ordinary one for flu in the right. It was like a conveyor belt: people were getting it every couple of minutes. It really is wonderful to see how well things can work when things go in the right direction. The battle with smoking-related respiratory illnesses continues. The Government’s plans on smoking cessation, including through the Tobacco and Vapes Bill, are welcome. I understand that the Bill’s Report stage is coming next week, or certainly the week after. We hope that it will have a big impact in more deprived areas and on outcomes. When we were doing our research, having meetings and doing an inquiry into the matter, it became clear that it was more of an issue in deprived areas and areas of disadvantage. I will say a wee bit more about that later. I hope that this debate will help to highlight World COPD Day, which falls on 20 November. I am sure that the Minister is well aware of the headline figures on respiratory health in the UK. They are worrying. The reason why this debate is so important is that the evidential base tells us that things are not getting better. That is why I look to the Minister for some succour, support and easement of mind. Respiratory disease is the third biggest killer in England. In the UK, 7.2 million people have asthma, while 3 million are affected by COPD. These are not just figures; they are people, and their families are affected as well. The UK has a higher death rate due to respiratory illness than the OECD average, and the highest death rate in Europe. My goodness! If that does not scare us, it should. Over the past 10 years, more than 12,000 people have died from asthma. All those deaths were preventable. That is another reason why we are having this debate: because if we can prevent deaths, we should. It is important to put this on the record.

Thank you for your chairmanship, Mr Rosindell. As an asthma sufferer, I know that one of the key elements of ensuring that we get the care we need is an annual survey with a clinician or GP about how our symptoms are either deteriorating or improving. I know many asthma sufferers who are not getting that annual review with their doctor. Some are going years without any sort of review of the deterioration of their symptoms. Given the really concerning number of people who die in this country from asthma attacks, is it not time that we did more to ensure that people get the yearly reviews they really need?

The hon. Member is absolutely right. If there are deaths of people with asthma that are attributable to not getting regular examinations or appointments with doctors or consultants, that is an issue that must be addressed. I am quite sure that the Minister is taking notes and that her civil servants and her Parliamentary Private Secretary will ensure that information is contributed to the debate. NHS waiting lists for respiratory care have risen by 263% over the past decade. Poorly controlled respiratory disease results in hospital admissions doubling during the winter period. COPD exacerbations are the second most common cause of emergency hospital admissions. These are worrying figures—as worrying as the issue to which the hon. Member for Redditch (Chris Bloore) refers. New research presented at the European Respiratory Society has shown that the biologics uptake for severe asthma is disastrously poor: the national median for patients in England with severe asthma between 2016 and 2023 is 16%. The uptake varied widely among integrated care boards: it was between 2% and 29% against a target of 50% to 60%. These are worrying figures that indicate an unfortunate trend that should concern us all. The burden of respiratory disease falls disproportionately on the most deprived. Adults in the poorest 10% of the country are more than two and a half times more likely to have COPD than the most affluent. The 10% most deprived children are four times more likely to require emergency admission to hospital due to asthma than the least deprived. Those figures show a fall-down and a need to focus on those areas. Lung conditions, especially asthma and COPD, cost the NHS £9.6 billion in direct costs this year and every year. That represents 3.4% of total NHS expenditure. Those conditions result in 12.7 million work days being lost every year. The stats indicate a massive problem that needs to be addressed. The illness and premature death associated with them causes reductions in productivity totalling some £4.2 billion a year, and the conditions have an overall impact of £13.8 billion on the English economy. All these stats tell us that we have a major problem. I ask the Minister that the NHS prioritise the issue. I understand that it was prioritised by the previous Government, but that that was not acted on because of the election, so I ask respectfully that it be prioritised in our strategy for the time ahead. Improving respiratory outcomes will help to achieve the Government’s ambitions to improve the nation’s health, to halve the disparities in health outcomes, to eliminate waiting lists, to break the winter crisis cycle and to enable everyone to live well for longer. I have a number of questions for the Minister; I think my staff have sent her a draft of my speech and the questions I will ask. Will she confirm that respiratory health will be a priority for the Government? That is my first big ask. The APPG strongly supports the Secretary of State’s three shifts, which were announced following the Darzi report. I very much welcome that report, and the Secretary of State has done extremely well: it was a difficult portfolio to take on, but he has shown that he has the ideas to take it forward strategically. I hope the Minister can provide an idea of how that will happen for those with respiratory health issues. The Darzi report proposes a shift from analogue to digital. We certainly have to improve the system that is used for our data and for healthcare more broadly, as the Secretary of State has said in the Chamber; I was very encouraged when I heard him talking about that shift. The other two shifts proposed are from hospital to community and from treatment to prevention. Those three should be front and centre, and they all have an important part to play in improving outcomes. The Government are right to highlight the impact of inequalities and deprivation on health. We strongly support their plans to achieve that through the three shifts, with which they have set a strategic course. The statistics are clear: we have to improve outcomes for the most vulnerable in society. Our No. 1 duty as elected representatives is to look out for our constituents, particularly those who are vulnerable—that is why we are elected representatives. Our duty is to look after those who are less well-off, those who are physically vulnerable, those who are disabled and those who have other issues in their life. Mortality rates from respiratory disease are higher among disadvantaged groups and areas of social deprivation, higher exposure to air pollution, higher smoking rates, poor housing conditions and exposure to occupational hazards. That has to be a major focus for us all. The trial of neighbourhood health centres could offer a significant shift from hospital to the community; the Government are considering that, and it is a good step in the right direction. We hope that we will enable a better focus for diagnosis and treatment of respiratory health, which could help to reduce inequalities. As the burden of respiratory disease disproportionately affects the most deprived parts of this great country, winter pressures are higher in those areas, so the centres need to be able to match the local challenges. Will the Minister indicate how that will happen? Part of the challenge relates to the provision of spirometry testing, which is an essential diagnostic tool for asthma and for COPD. Community diagnostic centres currently offer very few spirometry tests; some offer none at all. I ask the Minister to confirm that spirometry will be widely rolled out, especially in deprived areas where we need its use to be widespread in primary care. It would be extremely helpful if spirometry could receive sustainable funding to be equitably delivered. I welcome the Minister’s thoughts. As the Minister will be aware, the national screening committee has recommended introducing a targeted lung cancer screening programme across the UK. However, the screening programme only explores the possibility of lung cancer; unfortunately, it does not focus on addressing incidental findings of undiagnosed COPD identified during the screening. Including those findings would enable neighbourhood centres to help deliver better care for COPD. We are aware of some work being undertaken in Hull to roll incidental findings into potential COPD diagnoses. I ask the Minister and NHS England to look closely at the outcomes of that study, which I believe will give some direction on what needs to be done in the United Kingdom. We are deeply grateful to those in Hull who are working on COPD diagnosis. The national screening committee’s guidance on COPD has not been reviewed since 2019. I ask the Minister whether there are any plans to revisit that and to bring it up to date. It is five years since it was done, and the figures indicate a worrying trend of more disease. We need to have that in place. Overprescribing of SABA inhalers—short-acting beta agonists—remains a big problem. Guidelines would be of enormous help. I ask the Minister to ensure full support for the NHS to implement new guidelines. The APPG has been looking at the impact of inequality for some time. We highlighted that at our COPD event in the House at the end of last year. It was a well-attended event with constructive comments. As we always do in the APPG, off the back of that, we are looking forward more strategically, with a number of asks. We intend to hold regional events to enable local clinicians to inform us what more needs to be done. There is nothing better than asking clinicians the best way forward. They know. They deal with patients daily, and we deal regularly with constituents, and that helps us to focus attention, specifically on prevention. The number of asthma deaths is far too high. They are worryingly high, as the hon. Member for Redditch mentioned. It has to be a priority for us all to reduce deaths as quickly as possible and for that to be an integral marker in the 10-year plan. The Secretary of State is giving us a 10-year plan. Perhaps the Minister can tell us today where the asthma and respiratory health focus is in that 10-year plan. It needs to have that focus, and I hope we get that response from the Minister today. We are 10 years on from the national review of asthma deaths report and very little has changed in terms of asthma outcomes. A recent study showed that people on lower incomes reported greater use of oral corticosteroids than people on higher incomes. These findings highlight that there may be an increase in OCS prescriptions for people with asthma and COPD in more deprived areas. The study results are similar to those reported in the 2019 survey by Asthma and Lung UK. I again urge the Minister to keep an eye on that study, to see what lessons we can learn. I know the Minister is committed to making things better and we support her in her quest to do so, but I believe there are many who have helpful contributions on how that can be done. The APPG also welcomes improvements in inhaler technology, specifically the move to combination inhalers, which will ultimately eliminate the use of twin inhalers. That should benefit both asthma and COPD patients and will contribute to the NHS’s net zero targets. There are lots of things that have to be done. We all subscribe to the net zero targets—they need to be addressed—and this is a way of achieving two goals in one. We welcome the Government’s commitment to increasing the NHS workforce. That is very good news as well. We will see how that looks in the workforce plan next year. I ask the Minister to ensure that with a significant increase in staffing levels in primary care, we will see an end to untrained staff undertaking annual asthma reviews. I do not want to be too critical—that is not in my nature —but when there is an anomaly we have to address, it has to be said. The APPG warmly welcomes the promise of the outcomes of the 10-year plan, and we will submit our response to the consultation. To have any real impact on respiratory health, though, we believe the plan has to be disease specific and contain suitable outcome measures for respiratory health. Will the Minister confirm whether the plan will include disease-specific measures for respiratory health? Again, I ask the Minister to benchmark metrics at the start of the plan and to factor in regular outcome updates at three, seven and 10 years. If we do that at those points, we can chart the progress, or perhaps the lack of progress, and make improvements. The metrics could include fewer asthma deaths; reduced hospital admissions for asthma and COPD, especially winter admissions; prescription data; and reduced incidence of asthma and COPD in the most deprived areas. Interim data outcomes will enable us to determine whether the plan is on track to deliver the outcomes we all want to see. The use of biologics is of particular concern to the APPG and features regularly in our meetings. I am sorry to say that figures on the use of biologics in England are simply dreadful. The national median by patients with severe asthma in England between 2016 and 2023 sat at 16%, and the uptake varied widely among ICBs at between 2% and 29% against an uptake expectation within the clinical community of 50% to 60%. It just does not seem to be working. Biologics treatment has been described by our clinical advisers as life-saving for severe asthma patients. There is both wide regional variation in access, and unacceptable delays to the start of treatment. Many patients who need urgent treatment have to wait years to get access to the services that will prescribe biologics to them. That is an inefficient use of NHS resource and means that the health of patients is deteriorating while they wait for the right treatment. I do not want to see that, hon. Members do not want to see that, and I know the Minister does not want to see that either. We need more easily accessible severe asthma services. Again, I would be much obliged if the Minister could meet us to look at how we can provide better asthma care for those with the highest burden of disease. I hope that the NHS innovation and adoption strategy will put forward solutions to tackle low and variable uptake and the access to innovative treatments, such as severe asthma biologics. The APPG would like to see a funded transformation with the health innovation networks and clinical leadership on the implementation of NICE guidance on respiratory health at neighbourhood level and on the delivery of biologics. We are being constructive—the Minister knows that I will always be constructive because I believe we need to move forward together and ask the questions. I note the Secretary of State’s recent remarks on data sharing and the call by Asthma and Lung UK for greater data sharing in its report, which urges the Government to “Improve data collection and analysis across the care pathway to bring together primary and secondary data, and make high quality, publicly available data which will help ICSs target care where it is needed and ensure accountability”. We fully support that, and I do not think there is anybody in this room who would not support that, because it is absolutely the way forward. We are also looking closely at the recent increase in silicosis cases around the country, especially in relation to engineered stone. It is something that maybe not everybody is aware of, although I suspect those in this room are. There is a real threat that the rise in what are entirely preventable cases may add considerably to local health pressures. The Secretary of State has been clear that we need to address the waiting lists and take more action to prevent cases, and that is something I have suggested needs to be done as well. There are a number of recommendations in our silicosis report, and a key recommendation concerns wider data sharing between primary and secondary care. The APPG will hold a roundtable in the new year to ensure a timely discussion to inform the 10-year plan. I ask the Minister if she would be most kind and put it in her diary and come along. We are not here to give the Minister a hard time, but to take her contribution and help us to move forward together. The Parliamentary Private Secretary, the hon. Member for Aylesbury (Laura Kyrke-Smith), is not nodding because she cannot do that for the Minister, but she is indicating—I will send over the date, if that is okay. Since 2015, 250 to 300 patients have been diagnosed with CF each year. Despite medical advances in recent years, in 2022 the median age of death for those with CF was just 33. Wow—think about that. The Cystic Fibrosis Trust has called for greater financial support for people with cystic fibrosis for a number of years. In 2023, a University of Bristol study reported that a typical family with cystic fibrosis loses £6,800 a year due to the extra costs of living with that condition. The CF Trust has multiple requests, including for the Government to explore additional innovative market-incentive options to encourage the industry and others to fund research and trials for new antibiotics because of current antibiotic resistance. I believe we have seen a good and positive contribution to research and development, but we are probably at a cusp where a bit more investment and help would get us over the line. We need to prioritise diagnostics for antimicrobial-resistant infections to prevent further lung damage. The Trust’s final request is to implement an early warning alert system on pollution for people with respiratory conditions. I am looking forward to hearing what others have to say. The fact of the matter is that we have an opportunity this time because we have a Government who are spending £22 billion on the NHS. That is a massive amount of money. Every person in this great United Kingdom recognises what that means. It is the time to get it right. The Secretary of State has indicated that he is of that mind, and I know the Minister is also of that mind, so we have an opportunity to make effective change to the lives of people throughout this great United Kingdom of Great Britain and Northern Ireland. Some of the £22 billion will come to us in Northern Ireland through the Barnett consequentials, which is good news as well. It means that everybody gains across this great nation. I believe now is the time to act. We in the APPG want to do all in our power to inform, support and guide the Minister and her Department in effecting change and improving quality of life for those with respiratory health issues.

13:57:00

I start by joining the tributes to His Majesty the King on behalf of my constituents in Newcastle-under-Lyme as he marks his birthday today. It is excellent to see my hon. Friend the Minister in her position. I think it is the first time I have had a chance to speak when she has been on the Front Bench. It is very good to see her. I am also pleased to see that the shadow Minister’s brace has gone—evidence of the wonder of our national health service. I am grateful for the opportunity to speak in this debate. I congratulate the hon. Member for Strangford (Jim Shannon) on leading it and on his opening remarks. He clearly enjoyed the lack of time limit, and probably the typo in the Order Paper that said that the debate would last for three hours. I thank him for his contribution. I should declare an interest: my wife is a deputy sister in an intensive care unit. I remain in full admiration of her and all her colleagues who work in our national health service on a daily basis. My constituency is in the middle of our country, and air quality is one of the most important issues experienced by my constituents and one of the most frequently raised with me. It was with that in mind that I was delighted to host the Asthma and Lung UK reception in Parliament this Tuesday, where it launched its new report, “A Mission for Lung Health”. I encourage all colleagues present, all Members across the House and all those watching at home to read that report. Air quality and respiratory health are some of the most important issues experienced by my constituents. The hon. Member for Strangford highlighted the fact that respiratory conditions are the third biggest killer in the United Kingdom, and one in five of us will be diagnosed with a lung condition in our lifetime. Colleagues will have heard me talk about the disgraceful Walleys Quarry landfill site in my constituency. For far too long, the operators have got away with doing whatever they want and leaving our town smothered by the most horrendous levels of hydrogen sulphide emitting from the site. The levels of hydrogen sulphide have had an undeniable impact on the respiratory health of my constituents. I came down to London on Monday and will be heading back to my constituency shortly. I have had many reports from constituents back home that the levels have been horrendous this week. For us in Newcastle-under-Lyme, the fight for clean air is personal and it is constant. As I have the opportunity of the Floor, I make it clear again and reiterate to the Environment Agency, if it is listening: we need it to issue a closure notice with immediate effect to Walleys Quarry Ltd. We need to cap the site and restore it safely and swiftly.

I will happily give way to my hon. Friend from the west midlands.

Yes, the west midlands posse is here. I pay tribute to my hon. Friend for his work to draw attention to the disgraceful scenes at Walleys Quarry. We are having a conversation about the health of the nation, in particular air quality and the impact on respiratory health, and there is no doubt in my mind that the years of lack of action on that site have had an impact on people’s health. That cannot be allowed to continue.

We are on the way to getting my constituents the justice they deserve. I thank my hon. Friend for his support for our efforts, which have been led by many of my brilliant constituents, Dr Mick Salt, Lee Bernadette Walford, Simmo Burgess, Sheelagh Casey-Hulme and many others, who have been fighting hard. I could list many people. They did not all necessarily vote for me, but they have played an important role in helping to clean our air and save lives. In recent weeks, there has been a pretty furious rush on behalf of the borough council and an increase in demands placed on the new Government. That is all well and good, but as far as I can see, little representation seems to have been made by the borough council to the previous Government, or indeed to Staffordshire county council. The only theme among all three of those institutions is that they are led by politicians of the same party. My message to my constituents is that change has come, and I am determined to ensure that that change delivers. I hope that, after the profit-over-people approach of the operators at Walleys Quarry, we do not see that politics over people has prevented the site being closed and the respiratory health of my constituents being protected and enhanced. I will be grateful for an update from the Minister on what cross-departmental work has taken place in Government on such issues. Access to diagnostic testing for respiratory conditions is in dire need of reform, and the example and experiences of my constituents prove that well. Access to spirometry testing for lung conditions, in particular since the covid-19 pandemic, has been a slow and painful process for too many people across the country. It is estimated that in our United Kingdom, more than 600,000 people live with undiagnosed COPD; the hon. Member for Strangford touched on that. Even when restrictive respiratory conditions are suspected or diagnosed, people are waiting far too long for care. The latest NHS data shows that in August almost 5,000 people in Staffordshire—4,963, to be exact—were waiting beyond the national target of 18 weeks to be seen by a respiratory doctor. That is a little more than 50% of all patients referred for treatment. Although that is higher than the national average, it is sadly not an uncommon figure. It needs to change. When patients are diagnosed with a respiratory condition, the quality of care they receive often does not meet the standards set by NICE. Asthma and Lung UK, to which I pay tribute for all its work, has found that 70% of those living with asthma are not receiving all three aspects of basic care, and that the care received by more than 90% of those with COPD does not meet the five fundamentals required by NICE. People living with undiagnosed and poorly managed lung conditions are more susceptible to environmental factors such as air pollution, wintry weather and poor-quality housing, all of which, sadly, are applicable to the communities and people who live in the areas surrounding Walleys Quarry in Newcastle-under-Lyme. I would be grateful if the Minister took some time today—I am happy to talk at another time, too—to discuss strengthening the powers and scope of the UK Health Security Agency, because although it has an important role to play, most of that role is currently advisory. As colleagues have highlighted—the hon. Member for Strangford certainly did—lung conditions are more strongly associated with deprivation than any other major health condition. Sadly, the result of these combined factors is clear and, as the hon. Member noted, respiratory conditions are the largest driver of A&E admissions each winter. Thousands of people living with undiagnosed and poorly managed respiratory conditions end up in A&E, adding even more strain to a national health service that is already under strain. Last year, across the Staffordshire and Stoke-on-Trent integrated care board, 3,765 people were admitted to hospital in an emergency due to a lung condition. Yesterday, my right hon. Friend the Secretary of State for Health and Social Care reiterated this new Labour Government’s ambition to reform our national health service, but it is clear that that will not be achieved without prioritising respiratory health and care. That is entirely in line with the shifting focuses: from treatment to prevention, which has my full support; and from hospital to community care, where most respiratory care happens anyway. The Department should introduce a recovery fund of over £40 million over two years to increase the availability of testing. I know that is a big ask and I understand the financial pressures, but it would result in savings of £80 million for the national health service in reduced exacerbations, as well as a reduction of 85,474 hospital bed days. Lastly, I want to touch on the link between waste crime and respiratory health. This morning, I received an email from Councillor Robert Bettley-Smith, the chair of Betley parish council in Newcastle-under-Lyme. Although he is in a different party from mine, I appreciate the spirit in which he works with me as we seek to serve the people who elected us. Councillor Bettley-Smith noted the continuing activity on the land at Doddlespool Hall farm in my constituency. I will not go into all the detail, but the link between waste crime and the disposal of waste generally has a huge impact on respiratory health. Councillor Bettley-Smith noted that, apart from the waste issue, there appears to be evidence, based on smoke and smell, that tyres or similar materials are being burned, and have been burned in the last week or so. The failures to regulate the waste sector under the previous Government must be put right by this new one, and I look forward to working with Ministers across Government to do exactly that. There is a financial issue here, an environmental one and of course a health one too. I urge the excellent Minister to ensure that respiratory health is prioritised in the forthcoming 10-year plan for our beloved national health service and, importantly, in the upcoming review of the long-term workforce plan. I am grateful to the hon. Member for Strangford for introducing this debate, and I look forward to working with him, with the Minister and with colleagues across the House on these issues in the months and years ahead.

14:06:00

It is a pleasure to serve under your chairmanship, Mr Rosindell. I thank the hon. Member for Strangford (Jim Shannon) for securing this debate. We spent many years working on these issues together, when I was in opposition.

I am still here in opposition, but the hon. Lady is now over there on the Government Benches.

We worked together as part of the APPG for respiratory health. I pay tribute to the work of that APPG’s members, as well as to the clinicians and patient organisations involved, including Asthma and Lung UK and Action for Pulmonary Fibrosis. Respiratory illnesses have a disproportionate impact on the most deprived communities. In my constituency of Blaydon and Consett, the rates of conditions such as COPD are particularly elevated, and I have seen at first hand in my surgeries over the years how debilitating they can be; they can affect every part of a person’s life, from their mobility to their mental health, and tackling them is key to tackling health inequalities. Deprivation is linked not only to heightened rates of respiratory illness, but to faster rates of progression and poorer outcomes. That is true for terminal diagnoses such as pulmonary fibrosis, which has outcomes similar to common cancers, as well as for more common conditions such as asthma, which has seen a 25% increase in deaths over the past 10 years. We know that the biggest driver of preventable lung disease is smoking, which is responsible for half of the difference in life expectancy between our richest and poorest communities. I am pleased that this Government are taking the decisive action that is needed to protect future generations through legislation, and I am particularly proud of the work that has been done over a number of years by Fresh, which sees public health and ICBs working together to tackle this issue. Access to timely diagnoses and appropriate clinical pathways is vital for ensuring that people get the best possible treatment, but such access varies between conditions and areas of the UK. Of about 1.7 million people living with COPD in the UK, 600,000 are undiagnosed. Meanwhile, one person in every three has never heard of pulmonary fibrosis, which can lead to people receiving incorrect diagnoses, such as asthma. Incorrect diagnoses of severe asthma are common among children with the genetic condition primary ciliary dyskinesia. It is not a mild condition. In fact, children with PCD—I am not going to try to say it again—have a worse lung function than children with cystic fibrosis. It is vital that we do what we can to raise awareness of these conditions, including the rare condition of PCD, and their impact, whether they are primarily genetic in nature or driven by preventable causes. We know that our NHS is in a really difficult place, following 14 years of Conservative mismanagement. We lost 14 years in which we could have made progress to improve the lives of people living with these conditions, but instead, they were left extremely vulnerable to the pandemic, following a decade of under-investment and disastrous top-down reorganisation by the previous Government. That is not the fault of our NHS staff, who are working hard to provide services in very difficult situations—I want to be clear about that—but the state of our health service at present was laid bare in the Darzi report just a few weeks ago. Among many other things, the report specifically notes the poor outcomes for respiratory conditions in people with learning disabilities, as well as the link between the rise in these conditions and the growing levels of damp often found in the private rented sector. We have a long road to travel to fix the problems we have inherited, but I am proud to serve under a Government who are committed to huge investment in our NHS, and who have already made key steps towards a prevention agenda. Better public health and community care will be really important for tackling respiratory conditions and the shocking health inequalities that follow from them. I know that the Government have a sharp focus on preventive measures, such as those mentioned by the hon. Member for Strangford, and will look at how we can best improve our access to diagnostics and treatments, including biologics, for respiratory health.

14:12:00

I thank the hon. Member for Strangford (Jim Shannon) for bringing forward this important issue. Lung diseases are sadly prevalent in my constituency of Sherwood Forest. Diagnosis is often slow and prognosis is often devastating. Health inequalities in my constituency are stark, with people in the south of Nottinghamshire living an average seven and a half years longer than those living in the north of my constituency. Significant work across Nottinghamshire is being done regarding the diagnosis of lung cancer, and rightly so, but there are serious gaps in pathways for those suffering from lung diseases such as pulmonary fibrosis. Pulmonary fibrosis is a devastating disease, and its impact is felt acutely by those affected. I know at first hand that this relentless and often rapidly progressing condition drastically changes the lives of the people affected and their loved ones. They face a daily struggle of breathlessness, constant fatigue and the immense mental toll of facing a terminal illness with very limited treatment options. Simple tasks such as walking across a room become an enormous challenge. Yet pulmonary fibrosis lacks a focus that it desperately needs. Many people receive their diagnosis far too late, partly because the symptoms are often mistaken for less severe respiratory issues, and long waits for access to specialist care and life-extending treatment are very common. The disparities in access to these life-enhancing resources are unacceptable and must be addressed. Health inequalities play a significant role in accessing pulmonary fibrosis care, with those coming from a socially deprived background and living further from one of the few specialist centres likely to die sooner. I welcome the Secretary of State’s call for more specialist care to be available closer to home, as the current situation is particularly problematic for pulmonary fibrosis. I welcome the work of the national charity Action for Pulmonary Fibrosis in bringing together the community to implement a new pathway to improve many of the issues, and I hope the NHS will continue to focus on the implementation of that work. We have the opportunity to redesign services in a way that better aligns with local population needs and therefore enhances patient outcomes. I place on the record my thanks to those in the Nottingham University Hospitals NHS trust who work in respiratory care, particularly the lung nursing team, the healthcare assistants and Dr Saini, who are working endlessly to improve both diagnosis and prognosis. I know that at first hand, as sadly my father suffers from this cruel disease, and I have subsequently met many other sufferers and their carers. People with idiopathic pulmonary fibrosis are often misunderstood, as it has no known identified cause. They often feel lost and always feel ignored. The work to improve healthcare systems for pulmonary fibrosis requires collective effort, and I hope that today’s debate will pave the way for significant strides forward in how we address this heartbreaking disease so that those suffering are heard and understood.

14:16:00

I pay tribute to the hon. Member for Strangford (Jim Shannon) for all his work on the APPG for respiratory health. As has been said, it is a hugely important issue, given the sheer number of people affected and killed every year and the huge amount of resources taken from the NHS. It was good to hear everyone talk about a holistic approach, because this issue is not purely about NHS services. Most people have discussed the importance of air quality and pollution, and the hon. Member for Blaydon and Consett (Liz Twist) acknowledged that people living in poverty are more likely to suffer. I think they are five times more likely to die from COPD and about three times more likely to die from asthma. There are a whole variety of reasons for that, one being air pollution. In the village of Twyford near Winchester, one of our fantastic Lib Dem councillors has been campaigning for years to improve air quality and reduce pollution due to traffic. She is a former doctor, and one of her main motivations is to try to improve outcomes for asthma and children’s respiratory health. The Minister and I were in this Chamber about a week ago to discuss housing. It was acknowledged that the UK has the oldest housing stock in Europe, with a lot of it have been built before world war two. Again, the link between people living in poverty and living in substandard housing is very strong. I am probably not the only Member who receives correspondence from individuals in private housing association accommodation who struggle to get a response from organisations when they encounter problems such as mould. Living in substandard housing is bad not only for physical health, but for the environment and carbon dioxide emissions. Last week, we discussed a huge programme to try to improve the housing of people living in poverty, because it is good for the environment and for people’s health. We should remember that the NHS spends about £1.5 billion a year dealing directly with issues, such as damp and cold, that have arisen from people living in poor and substandard housing, so the comorbidities are huge. I am mindful talking about the clinical treatment of respiratory diseases when the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), is actually a doctor and I am a rudimentary veterinary surgeon, but respiratory disease is a common disease that we treat in horses. By improving the surroundings they are in—by getting rid of dust and improving ventilation—we can get the huge majority of them off medication entirely. It is the same with groups of cattle, which are housed over the winter. Respiratory diseases have a huge impact on farmers’ productivity, but through a combination of improving accommodation, improving ventilation and vaccination, we can get fewer illnesses and better productivity. That would be more cost-effective for the farmer and we would use fewer antibiotics. It is exactly the same with public health. Treating people who have got sick because they live in substandard conditions is an endless task, but getting to the root cause of the problem will have huge knock-on effects throughout society. Vaccines in human and veterinary medicine are always the most cost-effective health intervention. They are better for patients and the taxpayer and, importantly, they help us to avoid using antibiotics unnecessarily. The World Health Organisation has noted that antimicrobial resistance is one of the biggest health challenges facing the world right now. Interestingly, vaccine hesitancy is another, so we should monitor levels of vaccination uptake, because the tripledemic, as people call it, of flu, covid and respiratory syncytial virus affects people all year round, but especially in the winter. Slightly concerningly, it seems that 280,000 fewer NHS staff have been vaccinated this year compared with 2019, even though there are now slightly more frontline staff. Will the Minister explore why that is the case? Is it due to concerns about the vaccination or a lack of access to it? For example, I want to get vaccinated, but I just have not had the time yet this year, and that could be the problem for many people. Vaccinating pregnant women against RSV is a hugely important intervention that helps to prevent babies under six months old from getting really sick. Most people just get a cold from RSV, but tens of thousands of babies every year are admitted to hospital with it, and it can be hugely damaging in the long run. I have touched on holistic approaches to respiratory disease, but it is worth looking at other health conditions. The hon. Member for Strangford mentioned the work on smoking cessation, which is hugely important, but it is also worth noting the work on obesity. If a person is obese, any underlying respiratory issues are much more difficult to manage and treat, and the symptoms can often be exacerbated. We need to focus on public health interventions such as improving the quality of our food, including free school meals. I hope that, given the financial constraints the NHS is currently working under, we do not view public health as a cost to be cut, because in the long run we desperately need to invest in it to stop people getting sick and ending up in hospital. We will not prevent every disease, no matter how hard we try. People will still get sick for a whole variety of reasons, including with COPD, asthma and lung cancer, and they will need long-term management. In our manifesto, we called for people with long-term conditions to be able to see a named GP so that they get continuity of care from someone who is very familiar with their case. Seeing someone different every time causes patients a lot of stress and sometimes results in miscommunication. We discussed air pollution earlier. During the general election, we called for a new clean air Act, based on World Health Organisation recommendations and ideally enforced by a clean air agency. Will the Minister look seriously at that proposal, and consider other suggestions about working hard on local pollution levels, working to improve vaccination rates and housing standards, and working to ensure that anyone diagnosed with any type of cancer, but particularly lung cancer, sees a consultant within 62 days of being referred?

I omitted to put on the record earlier what a pleasure it is to serve under your chairmanship, Mr Rosindell. Before my election to this House, I spent five years working with my hon. Friend the Member for Newport West and Islwyn (Ruth Jones), who shadowed the Minister responsible for air quality, so I spent a lot of time working on these issues, particularly in respect of the World Health Organisation guidelines. Will the hon. Gentleman find the time for a cup of tea with me, so that we can see what we can do together to make the progress we all want to see?

Yes, I will. I live off tea—it is the only way I get through the day—and I have a particular interest in air quality, so it could be a really enjoyable meeting. As this debate is not going on for as long as the hon. Member for Strangford would like, he could come and speak with us as well. As I was saying, a clean air Act and a named doctor are among our proposals. We are heading into winter, which NHS staff must dread: it is always busier than other periods, and a whole load of respiratory issues add to the winter pressures on the NHS. I thank and pay tribute to all the NHS workers who are heading into this very difficult time. We must do whatever we can to support them, whether that is helping them to get their vaccinations or helping them in any other way.

14:26:00

It is a pleasure to serve under your chairmanship, Mr Rosindell. This is my first day in my new role; it seems appropriate to take over this brief and speak in a debate on respiratory illness, because dealing with respiratory illness was my first ward job as a junior doctor. I worked for four months in accident and emergency department in the west midlands, and then my first ward job was dealing with respiratory conditions in Solihull hospital, so I have seen up front just how important respiratory medicine is. I put on the record my thanks to the hon. Member for Strangford (Jim Shannon) for securing this debate. He may often get called last in the main Chamber, but he clearly has a trick for successfully securing debates. I look forward to perhaps having a cup of tea with him to learn how he is so successful. It is both a blessing and a curse to hear the hon. Member for Newcastle-under-Lyme (Adam Jogee) make the same argument that his predecessor made about the quality of air in his constituency. I gather that it is a tip that causes a huge amount of problems there, and I hope he has success in getting the issue sorted. I also hope he takes some comfort from the fact that the previous Government passed the Environment Act 2021 to put in place legal limits to try to improve air quality and, of course, offered air-quality grants. There is clearly an interest in respiratory conditions in both the east and west midlands, given the contribution from the hon. Member for Redditch (Chris Bloore), who is no longer in his place. Having worked over in the west midlands, I have now transferred to the clearly better east midlands.

I gently push back on the narrative that the previous Government made the sort of progress in tackling the issues at Walleys Quarry that the shadow Minister just implied. My constituents continue, on a daily basis, to deal with the worst effects of the hydrogen sulphide levels that the site emits. Hydrogen sulphide is a heavy gas and there are schools around the area. The impact on our children and the respiratory health of young lungs is massively underrated and fails to be part of the conversation. I invite the shadow Minister to come to Walleys Quarry and to Newcastle-under-Lyme to smell the situation for himself.

I am grateful for that offer, and if there is a cup of tea involved that may well be a consideration too. Perhaps we could all go there as a group on a cross-party trip.

There has been a lot of sobriety in this debate so, rather than having a cup of tea, I will take the shadow Minister to the Waggon and Horses pub in Newcastle-under-Lyme for a slightly colder refreshment.

I am very grateful to the hon. Gentleman for that offer. I congratulate the hon. Member for Blaydon and Consett (Liz Twist) on her work in the APPG. She was of course right to highlight smoking as a big problem, and health inequalities are also important. We also know that people experiencing health inequalities generally struggle to access healthcare, let alone healthcare for respiratory conditions—we have not even discussed the equipment and expertise needed to deal with such conditions. The hon. Member for Sherwood Forest (Michelle Welsh) spoke about pulmonary fibrosis, a really important condition that is not given the precedence it deserves given how debilitating it is for patients who suffer with it. I pay special tribute to her for raising that issue so powerfully and so emotionally. She is a true champion for doing something about a condition that is not thought about nearly enough. The hon. Member for Winchester (Dr Chambers) is absolutely right about holistic approaches. They are outside the remit of this debate, but housing, environment and smoking are of course all big factors. We have not even talked about comorbidities yet. We know that people over the age of 60 are usually on several medications and may have heart problems or musculoskeletal problems as well. That will have a really big impact. With regard to the hon. Member being a vet, I think I am right in thinking that he is still allowed to practise on humans, while I certainly am not allowed to practise on pets. That is not something for a debate today, but I think it is noteworthy; if there is a problem you should rush to him too, Mr Rosindell. What he said about antimicrobial resistance is really interwoven into everything, because there is a danger of over-prescriptions for chest infections that turn out to be viruses. That is a really problematic issue that is growing, and it is the next probable pandemic, with no easy solution. He is right to highlight that. I thank the members of the APPG for all the work they do, led by the hon. Member for Strangford. It is really important to be able to get a debate and raise these issues, and to have the infrastructure behind the members to support the team in dealing with and producing updates. I myself have a personal history with respiratory medicine, having ended up on the intensive care unit with bilateral pneumonia after an appendicectomy in my late 20s. It has left me, at previous times, at a brittle asthma clinic. There were many attempts to diagnose what was going on, but nothing was ever found. I had to be treated with repeated steroids and felt, full on, what it is like to suddenly not be able to breathe, not be able to exercise and have that ability taken away. When they are listening to this debate, the key thing for the public to realise is just how important our breathing really is. A breathing condition is so seminal to everything we do. There is a reason why in an emergency it is ABCDE, or airway, breathing, circulation, disability, exposure: because breathing is quite literally life. Many people have experienced having that taken away a little bit by getting covid; that has at least made people aware of just how bad viral illnesses can be. Turning to some of the other conditions that we have not talked about—I feel like I am back in one of my medical exams in the fifth year—we have heard about asthma and COPD, but we have not talked about pulmonary embolisms, pneumoconiosis or TB. We did hear about cystic fibrosis, but we have not heard about mesothelioma or sarcoidosis. Pneumonia is a really important one to talk about too, as is lung cancer, and there are probably some that I have missed. Respiratory conditions are really important: they make up the third place for all deaths, so they need that attention. I was therefore pleased to see the last Government come forward with the community diagnostic centres—170 community diagnostic centres going up across the country to get better access to MRI scans, CT scans or blood tests. Those will be really important, and I was lucky to have a £24 million investment for a CDC in Hinckley, which will have MRI and CT scanners, and is being built as we speak. That will be transformative for my community when they are caught between two big centres towards Nuneaton and Leicester. I hope those measures will mean that respiratory conditions play an important part in the hospital rebuild programme and the current review, and that we will ensure we have the apparatus and equipment to support them. Turning to the nitty-gritty of the debate, I entirely agree with the idea of prevention. The Conservatives brought forward measures to deal with smoking. I hope that as the Government step forward with further ideas of how to tackle smoking and push for a smoke-free generation, we will be looking at that very closely. The hon. Member for Strangford really hit on a point about data. Health policy must be driven by decent data, and the APPG’s work highlights how respiratory conditions tend to fall behind in that. I have questions for the Minister about what work is being done now only on the simple matter of how we record things, but on how we can join up that dataset. For example, in my constituency we have two boundaries; we are caught between North Warwickshire and Leicestershire when getting answers to tests. An asthmatic does not have an asthma attack directly where they live—they could be on holiday. Sharing information on what has happened with treatment and investigations is really important. That leads me on to spirometry. Spirometry is key, but where it is and how it is achieved is too sporadic, as is the skillset to deliver it. Then, of course, we have FENO—fractional exhaled nitric oxide—which can help to aid the diagnosis of asthma. That will be key, and the Opposition look forward to seeing what the new BTS guidelines, worked up with NICE, show on dealing with asthma. I have a couple more questions for the Minister. I appreciate that this is not her brief, so I should be grateful if she passed on any questions she cannot answer for a written response. We have heard that the likes of the RSV vaccine are really important; new vaccines are coming out to tackle this huge problem for the elderly and the young. The vaccine was introduced for those aged between 75 and 80, but it would be interesting to see whether there is scope to grow that and see who else is responsive. I gather from work done by my Opposition colleagues that there is still some debate to be had and evidence to be gathered on what that would look like. I would appreciate it if the Minister took that point away. What steps are the Government taking to increase the uptake of flu and pneumonia vaccinations? Prevention is better than cure. Finally, it was mentioned that the last Government looked at chronic health strategies. It appears that the new Government have decided to take a different tack with chronic conditions. I appreciate that that is their prerogative, but there is a danger that we could have a lag. The data that has been gathered, the research that has been looked at and the policies that have been structured for the past five years or so could fall by the wayside, even though we have heard how much of an emergency it is to deal with respiratory conditions. Could the Minister clarify whether interested parties will need to resubmit the work they have done, or whether the work will be a continuation within the new structure that the Government are planning? Is there any timescale on what that would look like? Clearly the Conservative Government were unable to get the long-term health strategies in place in time before the election. Time is ticking on, and we have a winter coming up. It is really important for organisations to understand where they stand. Christmas is coming up, and I well know from my time as a GP—I should declare an interest, as my wife is a GP as well—that Christmas is the busiest time, and respiratory conditions are one of the top reasons for that. If anyone out there is listening, getting vaccinated is imperative. I advise everyone to do so. We know that the staff of these organisations will go above and beyond when they see someone struggling for breath. They will take their time to get the right history and get medication and treatment in place. We give them our greatest thanks, from the Opposition side of the House, for all the work they have done and will do in the busy Christmas period. I am sure that that sentiment is shared by the Government.

14:37:00

It is a pleasure to serve under your chairmanship, Mr Rosindell, for the first time in my new role. I thank the hon. Member for Strangford (Jim Shannon) for securing this debate on an important issue, and I thank other Members for their contributions. As the hon. Member for Hinckley and Bosworth (Dr Evans) said, I am covering for my hon. Friend the Member for Gorton and Denton (Andrew Gwynne). I am pleased to do so. We had an outing this morning, and I was able to talk to the hon. Member for Hinckley and Bosworth earlier, whose first ward area was in this area as a medic. I must say that he is getting his money’s worth out of the NHS at the moment—I hope he does not have to do that again. One of my jobs as a manager some 15 years ago was with the British Thoracic Society and primary care leading physicians on COPD. It was a project about living and dying with COPD and helping people to understand the disease and navigate it. I learned an awful lot about respiratory disease at that time and how people live and die with it. I commend that work. I am shocked at some of what we have heard this afternoon and what I found in preparing for this debate about quite how poor things are, and that some basic preventive measures we were talking about 15, 16 or 17 years ago are still not in place. I am really happy to be responding this afternoon. I am not sure I will be able to satisfy everyone’s requests, but I can say on behalf of the Minister for Public Health and Prevention, my hon. Friend the Member for Gorton and Denton, that he will be happy to accept the invitation to the roundtable that the hon. Member for Strangford talks about, and his expertise will be better there than mine. We are keen to pursue that conversation with the hon. Gentleman and the all-party parliamentary group. As we have heard, one in five of us will be affected by a chronic respiratory disease at some point in our life. These conditions are, sadly, the third biggest contributor to years of life lost in England. Many people out and about using public transport will know the symptoms of poor respiratory health. They might associate a wheezing or raking cough with being indicative of a smoker, but not all ill health is about personal choice. In fact, this common symptom belies a huge range of conditions, only some of them related to smoking and each requiring different interventions. On all those conditions, we are taking forward a combination of immediate bold actions and long-term reforms. The Government are taking radical action to create the first smoke-free generation. We are clamping down on kids getting hooked on vapes and protecting children and vulnerable people from second-hand smoke. Tobacco is a uniquely harmful product and smoking is the No. 1 preventable cause of death, disability and ill health. The statistics are stark: smoking claims the lives of about 80,000 people a year in the UK and kills up to two thirds of its long-term users. Second-hand or passive smoke is extremely harmful to health. There is no safe level of exposure to smoke: if we can smell cigarette smoke, we are inhaling it. Smoke is harmful, particularly to children, pregnant women or people with pre-existing health conditions such as asthma or heart disease, which may not be visible to the smoker. Our Tobacco and Vapes Bill, which we introduced last week, will be the single biggest public health intervention since the last Labour Government banned smoking in indoor public spaces. The Bill’s primary aim is to create a smoke-free generation by gradually ending the sale of tobacco products throughout the country and breaking the cycle of addiction and disadvantage, so that someone born after 2009 will never be able to legally buy tobacco. This landmark legislation will also enable the Government to strengthen the existing ban on smoking in public places and to reduce the harms of passive smoking in certain outdoor settings. It will ban vapes and nicotine products from being promoted and advertised, to prevent the next generation from being hooked on nicotine. We will hear all sorts of arguments against these sorts of policies, with people saying it is the nanny state or that they are anti-growth. However, most smokers—myself included—always wish they had never started. They have had their choice taken away by addiction induced at a young age by the tobacco industry. I remind Members present that smoking costs the economy and wider society some £21.8 billion a year through lost productivity, smoking-related lost earnings, unemployment and early death, as well as the cost to the NHS and social care of over £3 billion. Our action will save thousands of lives and protect the NHS. I pay tribute to charities such as Action on Smoking and Health and Asthma and Lung UK, which have supported our work. Through our changes we will create a healthier society and, in doing so, boost the economy. As we have heard this afternoon, smoking is only one example of how our respiratory health is influenced by our environment. Even though it has been almost 70 years since the first Clean Air Act was passed, what we breathe remains one of the greatest risks to public health in the UK. As the chief medical officer’s 2022 annual report on air pollution sets out, there is clear evidence that outdoor air pollution contributes to the initiation and development of respiratory diseases such as lung cancer. That is why the Government are committed to a preventive approach in this policy area. I assure people that we are taking a mission-led approach, working across Departments to improve air quality. We want to address the inequalities in the quality of the air that people breathe simply because of where they live. The Department of Health and Social Care will support the Department for Environment, Food and Rural Affairs to deliver a comprehensive and ambitious clean air strategy. This will include a series of interventions to reduce emissions so that everyone’s exposure to air pollution is reduced. The UK Health Security Agency, which has been talked about this afternoon, is working closely with DEFRA to review how we communicate air-quality information to ensure that members of the public, and vulnerable groups in particular, have what they need to protect themselves. I commend my hon. Friend the Member for Newcastle-under-Lyme (Adam Jogee) for his work in support of his constituents with regard to Walleys Quarry. The Minister for Public Health and Prevention visited Newcastle-under-Lyme recently and will pursue those discussions with the Environment Agency. The Government are also taking steps to reduce risks to respiratory health in people’s homes—a point addressed well by the Liberal Democrat spokesperson, the hon. Member for Winchester (Dr Chambers). Living in a home with damp and mould increases the risk of respiratory illness and conditions such as asthma and COPD. It also affects symptom severity and the risk of death for individuals with existing respiratory conditions. We are therefore putting forward an initial £3.4 billion towards heat decarbonisation and household energy efficiency over the next three years, and £1.8 billion to support fuel poverty schemes. That means that over 225,000 households will receive help to reduce their energy bills by more than £200. The hon. Members for Winchester, for Strangford and for Hinckley and Bosworth made excellent points about vaccinations. We want to encourage everyone, including ourselves—I look around the room, even at myself; I am slightly behind on my flu vaccine—to do all we can ourselves and to encourage others to take up vaccines and prevent some of the related problems. We recognise, however, that not all ill health can be prevented, so we need to act to help those who need treatment. I assure the hon. Member for Strangford and other contributors that respiratory disease remains a clinical priority. The NHS long-term plan under the last Government set a series of objectives for improving outcomes for people with respiratory disease through early diagnosis and increased access to treatments. As we have heard, and as I have said, it is quite shocking that that basic objective is not being achieved everywhere. Access to checks and basic preventive care needs to be much better spread across the country. That is why we say that we want to take the best of the NHS to the rest of the NHS. NHS England has 13 respiratory clinical networks across the country, which are vital in providing clinical leadership across primary and secondary care for respiratory services and supporting services in primary care, where of course most patient contact is. I commend my hon. Friend the Member for Sherwood Forest (Michelle Welsh) for highlighting pulmonary fibrosis. I wish her father and her family well. She is absolutely right that early and accurate diagnosis is a priority for NHS England. Work to make improvements is under way, and that should have an impact on reducing delayed diagnoses of pulmonary fibrosis. As I understand it, access to these treatments has recently been expanded to patients with non-idiopathic pulmonary fibrosis, following the publication of the NICE technology appraisal for treating progressive fibrosing lung diseases. I hope that that goes some way towards reassuring my hon. Friend, who spoke so eloquently today. As the hon. Member for Strangford and my hon. Friends the Members for Newcastle-under-Lyme, for Blaydon and Consett (Liz Twist) and for Sherwood Forest highlighted, COPD is a major contributor to inequalities in life expectancy and in healthy life expectancy. People living in the most deprived parts of the country are five times more likely to die from COPD than those in the least deprived. I have seen that both in my previous work with those working in the NHS and since becoming the Member of Parliament for Bristol South in 2015. My constituency was home to the Wills tobacco company, a huge employer in the area over many decades. Its legacy can be seen in many different ways, but particularly in the very high rates of smoking in my constituency—up to 32% in some parts. The reduced lives lived in good health, and those shocking early deaths, are things that I see every day. The impact is still very apparent in the shocking statistics on health inequality across my home city of Bristol. Let me assure hon. Members that this issue remains a priority for all of us in this Government. Reducing health inequalities is a key part of our mission. That requires us to work across Government, and it runs across all parts of Government. In NHS England, Core20PLUS5 is a national approach to inform action to reduce healthcare inequalities at both national and local system level. The approach provides a vehicle for targeted interventions to detect and treat the diseases that are major contributors to life expectancy as well as pressures on the NHS. We know that there is a particular risk of condition exacerbation around the winter, leading to emergency treatment in hospital and in-patient care. That is why the focus of the Core20PLUS5 action on respiratory health this year has been to increase vaccination uptake, including covid-19, flu and pneumovax, which can protect against serious illnesses such as pneumonia and meningitis. NHS England is leading on the development of an approach for COPD management. This will support proactive identification and management of risk in patients in winter, to reduce demand on primary and secondary care. My hon. Friend the Member for Blaydon and Consett was absolutely right to highlight the low levels of diagnosis, the number of people living with COPD and other respiratory diseases, and the impact on children that we might not even know about. The plan is to test and evaluate this approach in four sites this winter to help inform decisions on winter planning in the future. On severe asthma and access to biologic treatment, significant work has been undertaken through the NHS England severe asthma collaborative to develop the capacity of the severe asthma centres. That important work includes streamlining patient pathways to biologic therapy and reducing variation in prescribing and patient management. Patient outcomes are now submitted to the UK severe asthma registry. That has led to improved identification of patients with potential severe asthma in primary and secondary care, resulting in referral to severe asthma centres for consideration of eligibility for biologic therapy. Action to address avoidable deaths from asthma has not gone far enough. That is why we are working to ensure that asthma care has a higher prioritisation within systems, for example through the national bundle of care for children and young people with asthma workstream, which is intended to improve outcomes for children and young people with asthma. Looking further forward, a central mission of the Government is to build healthcare that is fit for the future. As hon. Members have noted, our 10-year health plan will focus on the three shifts needed to deliver a modern NHS: from hospital to community, from analogue to digital and from sickness to prevention. That is a long-term challenge and those shifts will take time to deliver, so the plan will consider what immediate actions are needed to get the NHS back on its feet and bring waiting lists down, as well as the longer-term changes needed to make the health service fit for the future. I thank the hon. Member for Strangford for his commitment to respond to our engagement exercise. I encourage all organisations and individuals to contribute to the 10-year plan at change.nhs.uk. We are keen to work with the public, patients and our partners in all the organisations that support this work. We will listen and co-design the plan with them. Disease-specific and more general long-term conditions that affect people’s health are a very live issue. Given the level of comorbidities with which people currently live, it is important to look at the person as well as the diseases. We will continue to look at that as part of the development of the 10-year plan; I know that all hon. Members will take an active part in that process. The hon. Gentleman will tell me if there is anything to which I have not responded. The hon. Member for Hinckley and Bosworth asked for an update on the RSV vaccine. As part of my portfolio working on urgent and emergency care, we are looking closely at a vaccine update, as well as at the presentation of very young children with respiratory disease in the emergency care system; I am sure that he is aware of that issue. If there is anything else that he would like to know, I will ensure that he is written to. On spirometry and fractional exhaled nitric oxide tests, a look at the NICE guidelines is long overdue, so I hope that we see some more progress on that. If I have missed something, Members may write to the Minister for Public Health and Prevention and he will respond very promptly. I thank the hon. Member for Strangford and the APPG for raising the issue. I am genuinely very pleased to see it being raised. As a contributor to admissions and inequalities, it is a very serious disease and we need to highlight it. I thank him for the invitation to take part in a discussion with healthcare professionals on the way ahead for respiratory health. My ministerial colleagues look forward to discussing that further.

14:53:00

I thank everyone for their incredibly helpful contributions. It is no secret that I always look for a consensual debate, because that is more positive. That is what we have had today. We have had the opportunity to discuss many issues. With your indulgence, Mr Rosindell, I will speak to each. Since coming to this House, the hon. Member for Newcastle-upon-Lyme—

On a point of order, Mr Rosindell. My constituency is Newcastle-under-Lyme, not Newcastle-upon-Lyme as several colleagues have called it.

That will be on the record.

I will never get it wrong again. I thank the hon. Member for Newcastle-under-Lyme (Adam Jogee) for his contribution. Air quality has been a massive issue for him since he came to this House; he has reiterated that over and over again. I am hopeful that he will have the success for which he hopes. He referred to deprivation and low incomes as factors. Priority for respiratory health is needed, as the Minister confirmed. The hon. Member for Redditch (Chris Bloore) rightly referred to the need for regular asthma check-ups. It is always a pleasure to work alongside the hon. Member for Blaydon and Consett (Liz Twist). She and I have talked about this issue over the past five or six years. It was a pleasure to hear her contribution, which included first-hand evidence from her surgery. I agree that we need improved access to diagnostics and medical help. I thank the hon. Member for Sherwood Forest (Michelle Welsh) for her personal contribution; nothing tells a story better than a personal contribution. As the Minister says, we hope that her family members are able to deal with their issues in a positive fashion, and hopefully the medical care will be there as well. The hon. Lady referred to how the disease drastically changes lives, with some people being unable to walk. She also focused on charity work, which is really important. The hon. Member for Winchester (Dr Chambers) referred to air pollution, as his party has done for many years. He underlined the problems and the impact on children, and he referred to our old housing stock. These are critical issues. We sometimes forget about farmer’s lung, but those who live in the countryside do not, because it is a big issue. He also referred to RSV, the impact on pregnant women and the importance of vaccination. The shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), reminded us that his first job related to this issue. That has allowed him to make an incredible input into the debate: we thank him for everything that he has put forward. It is fair to say that the last Government had a plan, but a more holistic approach is needed. I thank him for his role on the APPG. Prevention is absolutely the way to go, and data is important. He also mentioned spirometry. The Minister responded in excellent fashion. I wrote down all the things she said. I thank her for committing to a meeting. I am sure that her colleague the hon. Member for Gorton and Denton (Andrew Gwynne) will be watching the debate and will respond. She referred to her former job and vocation, in which she had dealings with COPD directly. I am also grateful for the roundtable commitment. The Government have committed to a smoke-free society, on which a Bill is pending: that will be important in preventing lung cancer, especially for children. She also referred to damp in homes, an incredibly important issue that comes up all the time in the main Chamber. The Minister responded very positively, if I may say so, to all the issues on which we required answers, including vaccinations, energy efficiency and fuel poverty. The respiratory network across the nation deals with COPD and major contributors to respiratory health issues, and the Government are committed to it. Respiratory health and biologics are priorities for the Government. It is not often that we have a debate with so much input from everyone, and yet we have a Minister who answers all the questions. Question put and agreed to. Resolved, That this House has considered respiratory health.

14:58:00